Evidence map›Paper›PMID 26990957›Full record

SynthesisThe British journal of surgery2016

Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis.

V Sallinen, E A Akl, J J You, A Agarwal, S Shoucair, P O Vandvik, T Agoritsas, D Heels-Ansdell, G H Guyatt, K A O Tikkinen

Registry-linked trialOpen access · hybridAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The British journal of surgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04477824 (Is Acute Appendicitis Still a Clinical Diagnosis? Use of Preoperative Diagnostic Imaging Before Appendectomy in Denmark During 2000-15.), which is not on this map. Cited by 131 papers, 17 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
131citing papers in PubMed, 17 pooled it
29.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04477824 completednot on this map

Is Acute Appendicitis Still a Clinical Diagnosis? Use of Preoperative Diagnostic Imaging Before Appendectomy in Denmark During 2000-15.

TypeobservationalSponsorClaus Anders Bertelsen, PhD, MDRan2000 to 2016Enrolled82,000ConditionsAppendicitisArmsDiagnostic imaging
3 · Its place in the literature

Who cites it

131 citing papers in PubMed, 17 syntheses or guidelines pooled it, 257 citations in OpenAlex.

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  7. Rapid MRI Abdomen for Assessment of Clinically Suspected Acute Appendicitis in the General Adult Population: a Systematic Review.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2023
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  11. Magnetic resonance imaging (MRI) for diagnosis of acute appendicitis.The Cochrane database of systematic reviews · 2021
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  13. Guideline
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  18. Is it necessary to use specimen retrieval bag for reducing surgical site infection in laparoscopic appendectomy?A randomized controlled trial.Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES · 2023
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71 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 5 countries.

V SallinenDepartments of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
E A AklDepartment of Internal Medicine, American University of Beirut, Beirut, Lebanon.
J J YouDepartments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
A AgarwalDepartments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
S ShoucairUniversity of Balamand, Tripoli, Lebanon.
P O VandvikDepartment of Medicine, Innlandet Hospital Trust, Gjøvik, Norway.
T AgoritsasDepartments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
D Heels-AnsdellDepartments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
G H GuyattDepartments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
K A O TikkinenDepartments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
McMaster University · CAUniversity of Helsinki · FIInnlandet Hospital Trust · NOUniversity Hospital of Geneva · CHUniversity of Balamand · LB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFor more than a century, appendicectomy has been the treatment of choice for appendicitis. Recent trials have challenged this view. This study assessed the benefits and harms of antibiotic therapy compared with appendicectomy in patients with non-perforated appendicitis.

methodsA comprehensive search was conducted for randomized trials comparing antibiotic therapy with appendicectomy in patients with non-perforated appendicitis. Key outcomes were analysed using random-effects meta-analysis, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

resultsFive studies including 1116 patients reported major complications in 25 (4·9 per cent) of 510 patients in the antibiotic and 41 (8·4 per cent) of 489 in the appendicectomy group: risk difference -2·6 (95 per cent c.i. -6·3 to 1·1) per cent (low-quality evidence). Minor complications occurred in 11 (2·2 per cent) of 510 and 61 (12·5 per cent) of 489 patients respectively: risk difference -7·2 (-18·1 to 3·8) per cent (very low-quality evidence). Of 550 patients in the antibiotic group, 47 underwent appendicectomy within 1 month: pooled estimate 8·2 (95 per cent c.i. 5·2 to 11·8) per cent (high-quality evidence). Within 1 year, appendicitis recurred in 114 of 510 patients in the antibiotic group: pooled estimate 22·6 (15·6 to 30·4) per cent (high-quality evidence). For every 100 patients with non-perforated appendicitis, initial antibiotic therapy compared with prompt appendicectomy may result in 92 fewer patients receiving surgery within the first month, and 23 more experiencing recurrent appendicitis within the first year.

conclusionThe choice of medical versus surgical management in patients with clearly uncomplicated appendicitis is value- and preference-dependent, suggesting a change in practice towards shared decision-making is necessary.

Indexed as

Anti-Bacterial AgentsAppendectomyAppendicitisHumansLength of StayRecurrenceSick LeaveTreatment OutcomeAnti-Bacterial Agents

Identifiers

PMID26990957
PMCPMC5069642
OpenAlexW2298852443

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.